Estimated sdLDL-C/LDL-C Discordance Is Associated With Advanced Cardiovascular-Kidney-Metabolic Syndrome, Incident Cardiovascular Disease and Mortality: Evidence From Two Population-Based Cohorts.
Sun Honglin H, Cui Ruixiang R, Jiang Lanxuan L, Liu Jia J et al.
sdLDL-C is a more atherogenic subfraction of LDL particles. We aimed to investigate the associations of sdLDL-C and its discordance with LDL-C with advanced stages, incident cardiovascular disease (CVD) and mortality among adults across the cardiovascular-kidney-metabolic (CKM) syndrome spectrum. This study included adults from two cohorts: 16 992 participants from the National Health and Nutrition Examination Survey (NHANES, 1999-2018) and 8252 from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020) across CKM Stages 0-4. sdLDL-C was estimated (E-sdLDL-C) via Sampson's equation. Discordance was defined as an absolute E-sdLDL-C/LDL-C percentile difference of ≥ 10 percentiles. Logistic regression assessed advanced CKM, and Cox models evaluated associations with incident CVD in CHARLS and mortality in both cohorts. Survey-weighted analyses were applied in NHANES, and CHARLS models were fitted with community-level cluster-robust standard errors. Higher E-sdLDL-C at a given level of E-lbLDL-C and greater E-sdLDL-C/LDL-C discordance were each associated with increased advanced CKM prevalence across both cohorts (discordantly high vs. low in NHANES: OR: 2.89, 95% CI: 2.39-3.50). E-sdLDL-C at a given level of E-lbLDL-C was positively associated with incident CVD risk in CHARLS, whereas the discordance associations were attenuated after adjustment for baseline CKM stage. Each SD increment in discordance was associated with 15% higher all-cause and 20% higher cardiovascular mortality in NHANES, and 23% higher all-cause mortality in CHARLS. E-sdLDL-C and its discordance with LDL-C are associated with advanced CKM, incident CVD and mortality, suggesting that E-sdLDL-C/LDL-C discordance may reflect LDL-related lipid heterogeneity associated with adverse CKM outcomes.